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Sun Q, Jin C. Cell signaling and epigenetic regulation of nicotine-induced carcinogenesis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 345:123426. [PMID: 38295934 PMCID: PMC10939829 DOI: 10.1016/j.envpol.2024.123426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/22/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
Nicotine, a naturally occurring tobacco alkaloid responsible for tobacco addiction, has long been considered non-carcinogenic. However, emerging evidence suggests that nicotine may possess carcinogenic properties in mice and could be a potential carcinogen in humans. This review aims to summarize the potential molecular mechanisms underlying nicotine-induced carcinogenesis, with a specific focus on epigenetic regulation and the activation of nicotinic acetylcholine receptors (nAChRs) in addition to genotoxicity and excess reactive oxygen species (ROS). Additionally, we explore a novel hypothesis regarding nicotine's carcinogenicity involving the downregulation of stem-loop binding protein (SLBP), a critical regulator of canonical histone mRNA, and the polyadenylation of canonical histone mRNA. By shedding light on these mechanisms, this review underscores the need for further research to elucidate the carcinogenic potential of nicotine and its implications for human health.
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Affiliation(s)
- Qi Sun
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, 10010, USA; Department of Child and Adolescent Health, School of Public Health, China Medical University, Shenyang, Liaoning, 110013, China; Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, Shenyang, Liaoning, 110122, China
| | - Chunyuan Jin
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, 10010, USA; Perlmutter Cancer Center, NYU Langone Health, New York, NY, 10016, USA.
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2
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Valen H, Becher R, Vist GE, Holme JA, Mdala I, Elvsaas IKØ, Alexander J, Underland V, Brinchmann BC, Grimsrud TK. A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco. Int J Cancer 2023; 153:1942-1953. [PMID: 37480210 DOI: 10.1002/ijc.34643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/19/2023] [Accepted: 06/07/2023] [Indexed: 07/23/2023]
Abstract
The main objective of this systematic review was to assess cancer risk, and mortality after cancer diagnosis, for exclusive users of Swedish snus, compared with non-users of tobacco. We followed international standards for systematic reviews and graded our confidence in the risk estimates using the GRADE approach. Our search gave 2450 articles, of which 67 were assessed in full text against our inclusion criteria. Of these, 14 cohort-studies and one case-control study were included in the review. The studies investigated risk of cancer in the oral cavity or oropharynx (3 studies), esophagus (1 study), stomach (1 study), pancreas (2 studies), colorectum (2 studies), anus (1 study) and lung (1 study), as well as malignant lymphoma (1 study), leukemia and multiple myeloma (1 study), melanoma (1 study), any cancer (1 study) and mortality after cancer diagnosis (4 studies). Cancer risk could only be evaluated in men as there was a general lack of data for women. All included studies were evaluated to have a moderate risk of bias, mostly related to validity of exposure information. An increased risk of cancer of the esophagus, pancreas, stomach and rectum as well as an association between use of snus and increased mortality after a cancer diagnosis was reported. Our confidence in the various risk estimates varied from moderate through low to very low.
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Affiliation(s)
- Håkon Valen
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nordic Institute of Dental Materials, Oslo, Norway
| | - Rune Becher
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nordic Institute of Dental Materials, Oslo, Norway
| | - Gunn Elisabeth Vist
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Jørn Andreas Holme
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ibrahimu Mdala
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Norway
| | | | - Jan Alexander
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Vigdis Underland
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Bendik Christian Brinchmann
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
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3
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Lee PN, Coombs KJ, Hamling JS. Review with meta-analysis relating North American, European and Japanese snus or smokeless tobacco use to major smoking-related diseases. World J Meta-Anal 2022; 10:130-142. [DOI: 10.13105/wjma.v10.i3.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/25/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While extensive information exists relating cigarette smoking to the risk of lung cancer, chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD) or acute myocardial infarction (AMI), and stroke, far less information is available on risks from moist snuff (“snus”) or smokeless tobacco (ST) in United States/Canada, Europe or Japan.
AIM To summarize data from the selected countries on risks of the four diseases associated with current ST or snus use.
METHODS Publications in English in 1990-2020 were considered that, based on epidemiological studies in North America, Europe or Japan, estimated risks of lung cancer, COPD, IHD/AMI, or stroke according to use of ST or snus. The studies should involve at least 100 cases of the disease considered, and not be restricted to those with specific other diseases. Medline literature searches were conducted, selecting papers initially from examination of titles and abstracts, and then from full texts. Further papers were sought from reference lists in selected papers, reviews and meta-analyses. For each disease, relative risk estimates adjusted at least for age were extracted relating ST or snus use to risk, and combined using random-effects meta-analysis. The estimates were mainly for current vs. never or non-current use, but results for ever vs never use were also considered.
RESULTS Seven publications reported results for ST use from six United States studies. The most useful results came from four studies which provided results for current vs. never use. Random-effects meta-analyses of these results showed an increased risk for each disease, clearest for lung cancer (relative risk 1.59, 95% confidence interval 1.06-2.39, based on 4 estimates) and COPD (1.57, 1.09-2.26, n = 3), but also significant (at P < 0.05) for IHD (1.26, 1.10-1.45, n = 4) and stroke (1.27, 1.03-1.57, n = 4). Also including results for ever vs. never use from two other studies increased the lung cancer estimate to 1.80 (1.23-2.64, n = 6), but had little effect on the other estimates. For snus, 16 publications described results from 12 studies, one in Norway and the rest in Sweden. There were no results for COPD, and only three for lung cancer, with these reporting a relative risk of 0.80 (0.40-1.30) for current vs never use. More extensive data were available for IHD/AMI and stroke. Using the latest results from each study, combined estimates for current vs. never use were 1.00 (0.91-1.11, n = 5) for IHD/AMI and 1.05 (0.95-1.17, n = 2) for stroke, while for current vs. non-current use they were 1.10 (0.92-1.33, n = 9) for IHD/AMI and 1.12 (0.86-1.45, n = 9) for stroke. Meta-analyses including earlier results from some studies also showed no significant association between snus use and IHD/AMI or stroke. No relevant results were found for Japan.
CONCLUSION Risks of smoking-related diseases from snus use in Scandinavia are not demonstrated, while those from ST use in the United States are less than from smoking.
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Affiliation(s)
- Peter Nicholas Lee
- Department of Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd, Sutton SM2 5DA, Surrey, United Kingdom
| | - Katharine Jane Coombs
- Department of Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd, Sutton SM2 5DA, Surrey, United Kingdom
| | - Janette Susan Hamling
- Department of Medical Statistics and Epidemiology, RoeLee Statistics Ltd, Sutton SM2 5DA, Surrey, United Kingdom
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4
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Hajat C, Stein E, Ramstrom L, Shantikumar S, Polosa R. The health impact of smokeless tobacco products: a systematic review. Harm Reduct J 2021; 18:123. [PMID: 34863207 PMCID: PMC8643012 DOI: 10.1186/s12954-021-00557-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. METHODS We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar. RESULTS Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. 'Poor'-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson's disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products. CONCLUSION Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation.
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Affiliation(s)
- C Hajat
- Public Health Institute, UAE University, Abu Dhabi, 15551, UAE.
| | - E Stein
- Independent Researcher, New York, USA
| | - L Ramstrom
- Independent Researcher, Institute for Tobacco Studies, Stockholm, Sweden
| | - S Shantikumar
- Warwick Medical School, University of Warwick, Coventry, UK
| | - R Polosa
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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5
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Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors. Nat Rev Gastroenterol Hepatol 2021; 18:493-502. [PMID: 34002083 PMCID: PMC9265847 DOI: 10.1038/s41575-021-00457-x] [Citation(s) in RCA: 342] [Impact Index Per Article: 114.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Abstract
Pancreatic cancer is a leading cause of cancer death worldwide and its global burden has more than doubled over the past 25 years. The highest incidence regions for pancreatic cancer include North America, Europe and Australia, and although much of this increase is due to ageing worldwide populations, there are key modifiable risk factors for pancreatic cancer such as cigarette smoking, obesity, diabetes and alcohol intake. The prevalence of these risk factors is increasing in many global regions, resulting in increasing age-adjusted incidence rates for pancreatic cancer, but the relative contribution from these risk factors varies globally due to variation in the underlying prevalence and prevention strategies. Inherited genetic factors, although not directly modifiable, are an important component of pancreatic cancer risk, and include pathogenic variants in hereditary cancer genes, genes associated with hereditary pancreatitis, as well as common variants identified in genome-wide association studies. Identification of the genetic changes that underlie pancreatic cancer not only provides insight into the aetiology of this cancer but also provides an opportunity to guide early detection strategies. The goal of this Review is to provide an up-to-date overview of the established modifiable and inherited risk factors for pancreatic cancer.
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Hemminki K, Försti A, Hemminki A, Ljungberg B, Hemminki O. Incidence trends in bladder and lung cancers between Denmark, Finland and Sweden may implicate oral tobacco (snuff/snus) as a possible risk factor. BMC Cancer 2021; 21:604. [PMID: 34034676 PMCID: PMC8152093 DOI: 10.1186/s12885-021-08371-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The dominant risk factor for urinary bladder cancer has been cigarette smoking, but, as smoking prevalence is decreasing in many populations, other risk factors may become uncovered. Such new risk factors could be responsible for halting the declining incidence of bladder cancer. We hypothesize that snuff use by Swedish men may increase the rate for bladder cancer, as snuff contains carcinogenic nitrosamines. Methods We carried out an ecological study by comparing incidence trends in lung and bladder cancers between Danish, Finnish and Swedish men in order to test if the Swedish bladder cancer rate deviates from the Danish and Finnish ones. We used the NORDCAN database for cancer data from 1960 through 2016 to test the hypothesis. Results In the three countries, the incidence of lung cancer started to decrease after a peak incidence, and this was later followed by declining incidence in bladder cancer in Denmark from 1990 to 2016 by 14.3%, in Finland by 8.3% but not in Sweden (the decline of 1.4% was not significant). The difference in trends can be partly explained by the increasing incidence in Swedish men aged 70 or more years. Sweden differs from the two other countries by low male smoking prevalence but increasing use of snuff recorded by various surveys. Conclusion The stable bladder cancer trend for Swedish men was opposite to the declining trends in Denmark, Finland and globally. We suggest that this unusual finding may be related to the increasing use of snuff by Swedish men. Average users of snuff are exposed to at least 3 times higher levels of carcinogenic tobacco-specific nitrosamines than a smoker of one daily pack of cigarettes. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08371-w.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic. .,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Otto Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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7
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Rodu B, Plurphanswat N. Heterogeneity and other problems in a pooled analysis of snus use and mortality. F1000Res 2021; 10:388. [PMID: 35316937 PMCID: PMC8917321 DOI: 10.12688/f1000research.52127.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Abstract
A recent analysis of Swedish snus use and mortality combined eight Swedish datasets and found that exclusive Swedish male snus users have statistically significant increased mortality from all causes, cardiovascular diseases and other causes. These findings, from the Swedish Collaboration on Health Effects of Snus Use, are in sharp contrast with previous pooled results from the same group. The discrepant results may be indicative of unresolved statistical problems that haven’t been addressed by the collaboration authors in any of their studies. The most important problem is unresolved heterogeneity among the eight cohorts, which we describe in detail, and we show how the use of the random effects method by the authors was not sufficient. We explain why the tables in the article are uninformative, and we demonstrate why the exclusion of smokers in the analysis was not validated and eliminated important information. Finally, we strongly recommend some straightforward and easily implemented corrective measures.
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Affiliation(s)
- Brad Rodu
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, 40202, USA
- Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
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8
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Kasper AM, Close GL. Practitioner observations of oral nicotine use in elite sport: You snus you lose. Eur J Sport Sci 2021; 21:1693-1698. [PMID: 33263462 DOI: 10.1080/17461391.2020.1859621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The elite sport environment is one where athletes strive to find a competitive edge, through improved recovery modalities, cognitive performance or physical capacity. Due to this, non-scientifically evidenced and/or pseudo-scientific alternative remedies are ever popular. Snus (an oral tobacco based product containing the highly addictive compound nicotine) is one alternative 'physical and psychological performance enhancer', purported to act as a 'mental and physical booster', 'relaxative' and even as an 'appetite suppressor'. Despite snus having serious adverse health effects, along with no proven benefit to physical or mental performance, observations by the authors working in professional sport, along with several reports in the mainstream media, would suggest that the use of snus in elite sport appears to be increasing. Perhaps most worrying, the use of snus has been reported to be prevalent within younger athletes. It is crucial that athletes are fully educated with regards to the health implications of snus and other oral tobacco-based products, whilst practitioners should be aware of its growing prevalence in sport with strategies in place to discourage its use.
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Affiliation(s)
- Andreas M Kasper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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9
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Araghi M, Galanti MR, Lundberg M, Liu Z, Ye W, Lager A, Engström G, Alfredsson L, Knutsson A, Norberg M, Wennberg P, Lagerros YT, Bellocco R, Pedersen NL, Östergren PO, Magnusson C. No association between moist oral snuff (snus) use and oral cancer: pooled analysis of nine prospective observational studies. Scand J Public Health 2020; 49:833-840. [PMID: 32466721 DOI: 10.1177/1403494820919572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims: Worldwide, smokeless-tobacco use is a major risk factor for oral cancer. Evidence regarding the particular association between Swedish snus use and oral cancer is, however, less clear. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between snus use and oral cancer. Methods: A total of 418,369 male participants from nine cohort studies were followed up for oral cancer incidence through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. Results: During 9,201,647 person-years of observation, 628 men developed oral cancer. Compared to never-snus use, ever-snus use was not associated with oral cancer (adjusted HR 0.90, 95% CI: 0.74, 1.09). There were no clear trends in risk with duration or intensity of snus use, although lower intensity use (⩽ 4 cans/week) was associated with a reduced risk (HR 0.65, 95% CI: 0.45, 0.94). Snus use was not associated with oral cancer among never smokers (HR 0.87, 95% CI: 0.57, 1.32). Conclusions: Swedish snus use does not appear to be implicated in the development of oral cancer in men.
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Affiliation(s)
- Marzieh Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Zhiwei Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden
| | | | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | | | - Ylva Trolle Lagerros
- Clinical Epidemiology Unit, Karolinska Institutet, Sweden.,Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | | | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden
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Clarke E, Thompson K, Weaver S, Thompson J, O’Connell G. Snus: a compelling harm reduction alternative to cigarettes. Harm Reduct J 2019; 16:62. [PMID: 31775744 PMCID: PMC6882181 DOI: 10.1186/s12954-019-0335-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/06/2019] [Indexed: 12/31/2022] Open
Abstract
Snus is an oral smokeless tobacco product which is usually placed behind the upper lip, either in a loose form or in portioned sachets, and is primarily used in Sweden and Norway. The purpose of this review is to examine the reported effects of snus use in relation to specified health effects, namely lung cancer, cardiovascular disease, pancreatic cancer, diabetes, oral cancer and non-neoplastic oral disease. The review also examines the harm reduction potential of snus as an alternative to cigarettes by comparing the prevalence of snus use and cigarette smoking, and the reported incidence of tobacco-related diseases across European Union countries. The scientific literature generally indicates that the use of snus is not a significant risk factor for developing lung cancer, cardiovascular disease, pancreatic cancer or oral cancer. Studies investigating snus use and diabetes have reported that high consumption of snus (estimated as being four or more cans per week) may be associated with a higher risk of developing diabetes or components of metabolic syndrome; however, overall results are not conclusive. Snus use is associated with the presence of non-neoplastic oral mucosal lesions which are reported to heal rapidly once use has stopped. The most recent Eurobarometer data from 2017 reported that Sweden had the lowest prevalence of daily cigarette use in the European Union at 5% whilst daily "oral tobacco" use was reported to be 20%. European data published by the World Health Organisation in 2018 indicated that Sweden had the lowest rate of tobacco-related mortality and the lowest incidence of male lung cancer. Overall, prevalence statistics and epidemiological data indicate that the use of snus confers a significant harm reduction benefit which is reflected in the comparatively low levels of tobacco-related disease in Sweden when compared with the rest of Europe. The available scientific data, including long-term population studies conducted by independent bodies, demonstrates that the health risks associated with snus are considerably lower than those associated with cigarette smoking.
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Affiliation(s)
| | - Keith Thompson
- Elucid8 Holdings Ltd, Ballymena Business Centre, 62 Fenaghy Road, Ballymena, BT42 1FL UK
| | - Sarah Weaver
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Joseph Thompson
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Grant O’Connell
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
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Ranjani S, Kowshik J, Sophia J, Nivetha R, Baba AB, Veeravarmal V, Joksić G, Rutqvist LE, Nilsson R, Nagini S. Activation of PI3K/Akt/NF-kB Signaling Mediates Swedish Snus Induced Proliferation and Apoptosis Evasion in the Rat Forestomach: Modulation by Blueberry. Anticancer Agents Med Chem 2019; 20:59-69. [PMID: 31696813 DOI: 10.2174/1871520619666191024115738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/23/2019] [Accepted: 07/17/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The present study was undertaken to ascertain whether the modulatory effects of blueberries on cell proliferation induced by Swedish snus in the rat forestomach epithelium is mediated via abrogation of the PI3K/Akt/NFκB signaling axis that regulates cell fate decision. METHODS The transcript and protein expression of genes involved in cell cycle progression and apoptosis, as well as canonical PI3K/Akt/NF-κB signaling pathways, were analyzed by qRT-PCR, immunoblotting and ELISA. Expression profiling of noncoding RNAs (ncRNAs) that influence PI3K/Akt/NF-κB signaling was undertaken. TUNEL assay was performed using flow cytometry. RESULTS Administration of snus induced basal cell hyperplasia in the rat forestomach with increased cell proliferation and inhibition of apoptosis. This was associated with the activation of PI3K/Akt/NFκB signaling. Coadministration of blueberries significantly suppressed snus-induced hyperplasia. Analysis of the molecular mechanisms revealed that blueberries suppress the phosphorylation of Akt, NF-κB and IKKβ, prevent nuclear translocation of NF-κB and modulate the expression of microRNAs that influence PI3K/Akt/NF-κB signaling. CONCLUSION Taken together, the results of the current study provide compelling evidence that blueberries exert significant protective effects against snus-induced soft tissue changes in the rat forestomach epithelium mediated by inhibiting key molecular players in the PI3K/Akt/NF-κB signaling axis. Long-term studies on the impact of snus exposure on various cellular processes, signaling pathways, and the interplay between genetic and epigenetic mechanisms are however warranted. The results of this investigation may contribute to the development of protection against soft tissue changes induced by smokeless tobacco in the human oral cavity.
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Affiliation(s)
- Singaraj Ranjani
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
| | - Jaganathan Kowshik
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
| | - Josephraj Sophia
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
| | - Ramesh Nivetha
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
| | - Abdul B Baba
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
| | - Veeran Veeravarmal
- Division of Oral and Maxillofacial Pathology, Rajah Muthiah Dental College and Hospital, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
| | - Gordana Joksić
- Vinca Institute of Nuclear Sciences, Laboratory for Physical Chemistry, University of Belgrade, Mike PetrovicaAlasa 12-14, Belgrade 11001, Serbia
| | | | - Robert Nilsson
- Vinca Institute of Nuclear Sciences, Laboratory for Physical Chemistry, University of Belgrade, Mike PetrovicaAlasa 12-14, Belgrade 11001, Serbia
| | - Siddavaram Nagini
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
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Price LR, Martinez J. Biological effects of nicotine exposure: A narrative review of the scientific literature. F1000Res 2019; 8:1586. [PMID: 32595938 PMCID: PMC7308884 DOI: 10.12688/f1000research.20062.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 09/07/2023] Open
Abstract
The emergence of new tobacco heating products and electronic nicotine delivery systems (ENDS) is changing the way humans are exposed to nicotine. The purpose of this narrative review is to provide a broad overview of published scientific literature with respect to the effects of nicotine on three key health-related areas: 1) cardiovascular risk, 2) carcinogenesis and 3) reproductive outcomes. These areas are known to be particularly vulnerable to the effects of cigarette smoke, and in addition, nicotine has been hypothesized to play a role in disease pathogenesis. Acute toxicity will also be discussed. The literature to February 2019 suggests that there is no increased cardiovascular risk of nicotine exposure in consumers who have no underlying cardiovascular pathology. There is scientific consensus that nicotine is not a direct or complete carcinogen, however, it remains to be established whether it plays some role in human cancer propagation and metastasis. These cancer progression pathways have been proposed in models in vitro and in transgenic rodent lines in vivo but have not been demonstrated in cases of human cancer. Further studies are needed to determine whether nicotine is linked to decreased fertility in humans. The results from animal studies indicate that nicotine has the potential to act across many mechanisms during fetal development. More studies are needed to address questions regarding nicotine exposure in humans, and this may lead to additional guidance concerning new ENDS entering the market.
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Affiliation(s)
- Leonie R. Price
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
| | - Javier Martinez
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
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Price LR, Martinez J. Cardiovascular, carcinogenic and reproductive effects of nicotine exposure: A narrative review of the scientific literature. F1000Res 2019; 8:1586. [PMID: 32595938 PMCID: PMC7308884 DOI: 10.12688/f1000research.20062.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
The emergence of new tobacco heating products and electronic nicotine delivery systems (ENDS) is changing the way humans are exposed to nicotine. The purpose of this narrative review is to provide a broad overview of published scientific literature with respect to the effects of nicotine on three key health-related areas: 1) cardiovascular risk, 2) carcinogenesis and 3) reproductive outcomes. These areas are known to be particularly vulnerable to the effects of cigarette smoke, and in addition, nicotine has been hypothesized to play a role in disease pathogenesis. Acute toxicity will also be discussed. The literature to February 2019 suggests that there is no increased cardiovascular risk of nicotine exposure in consumers who have no underlying cardiovascular pathology. There is scientific consensus that nicotine is not a direct or complete carcinogen, however, it remains to be established whether it plays some role in human cancer propagation and metastasis. These cancer progression pathways have been proposed in models in vitro and in transgenic rodent lines in vivo but have not been demonstrated in cases of human cancer. Further studies are needed to determine whether nicotine is linked to decreased fertility in humans. The results from animal studies indicate that nicotine has the potential to act across many mechanisms during fetal development. More studies are needed to address questions regarding nicotine exposure in humans, and this may lead to additional guidance concerning new ENDS entering the market.
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Affiliation(s)
- Leonie R. Price
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
| | - Javier Martinez
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
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14
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Lund I, Moan IS, Edvardsen HME. The relative impact of smoking, alcohol use and drug use on general sickness absence among Norwegian employees. BMC Public Health 2019; 19:500. [PMID: 31053139 PMCID: PMC6499980 DOI: 10.1186/s12889-019-6891-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well documented that tobacco, alcohol and drug use can be detrimental to health. However, little is known about the relative impact of these factors on sickness absence, and whether the association between use of these substances and sickness absence is different for women and men. The aim of this study was to examine the association between tobacco-, alcohol- and drug use, as well as polydrug use, and sickness absence among Norwegian employees. METHODS During 2011-2014, 1911 employees in Norway completed a questionnaire about their tobacco, alcohol and drug use habits, their total number of sickness absences during the last 12 months, and the length (no. of days) of their last sick leave. Samples of oral fluid were analysed for illegal and medicinal drugs. RESULTS Daily smoking and current use of medical drugs were significantly associated with sickness absence. Employees who were daily smokers also had an increased likelihood of having long and frequent sickness absence. Use of snus (Swedish moist snuff), binge drinking, current use of illegal drugs and polydrug use were not significantly associated with sickness absence. Women and young participants were more likely to report having had sickness absence the past 12 months. However, the associations between daily smoking and medical drug use and sickness absence, respectively, were only statistically significant for men. CONCLUSION According to this study, daily smoking and use of medical drugs are the substance use habits most closely associated with sickness absence. Implications for future research are discussed.
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Affiliation(s)
- Ingeborg Lund
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, PO Box 222, Skøyen, N-0213, Oslo, Norway.
| | - Inger Synnøve Moan
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Hilde Marie Erøy Edvardsen
- Oslo University Hospital, Department of Forensic Sciences, Section of Drug Abuse Research, Kirkeveien 166, N-0450, Oslo, Norway
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15
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Joksić G, Rutqvist LE, Mićić M, Tričković JF, Nilsson R. Factors effecting the induction of rat forestomach hyperplasia induced by Swedish oral smokeless tobacco (snus). Regul Toxicol Pharmacol 2019; 104:21-28. [PMID: 30844416 DOI: 10.1016/j.yrtph.2019.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/23/2019] [Accepted: 02/24/2019] [Indexed: 01/27/2023]
Abstract
Long term exposure to oral smokeless tobacco may induce lesions in the oral cavity characterized by a hyperplastic epithelium. The possible role of nicotine and the physical properties of oral tobacco for developing these lesions, as well as of dysplasia and neoplasia is unclear. Low nitrosamine Swedish snus as well as non-genotoxic butylated hydroxyanisole induces increased cellular proliferation in the rat forestomach epithelia. Using this model, we report here on the effects of nicotine, pH, and particle size. Snus with different properties had no impact on oxidative stress as determined by 8-oxo-7,8-dihydro-2'-deoxyguanosine, or on interleukin IL-1b. Whereas BHA boosted IL-6, probably due to the presence of nicotine. there was no significant enhancement of cell divisions with increasing particle size, although in individual samples the variations in proliferation rates increased greatly with increasing particle size. Conforming to human experience, the enhanced cell proliferation caused by snus was found to be completely reversible. A cacao bean extract had a protective action similar to that previously found for blueberries. The main cause of the observed tobacco induced cell proliferation could be mechanical irritation, possibly in combination with nicotine, whereas within the studied range, pH did not affect the rate of cell division.
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Affiliation(s)
- Gordana Joksić
- Vinča Institute of Nuclear Sciences, Department of Physical Chemistry, University of Belgrade, POB 522, 11000, Belgrade, Serbia
| | | | - Mileva Mićić
- Institute for Medical Research, University of Belgrade, POB 49, 11000, Belgrade, Serbia
| | - Jelena Filipović Tričković
- Vinča Institute of Nuclear Sciences, Department of Physical Chemistry, University of Belgrade, POB 522, 11000, Belgrade, Serbia
| | - Robert Nilsson
- Vinča Institute of Nuclear Sciences, Department of Physical Chemistry, University of Belgrade, POB 522, 11000, Belgrade, Serbia.
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Barua RS, Rigotti NA, Benowitz NL, Cummings KM, Jazayeri MA, Morris PB, Ratchford EV, Sarna L, Stecker EC, Wiggins BS. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2018; 72:3332-3365. [PMID: 30527452 DOI: 10.1016/j.jacc.2018.10.027] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Bergsvik D, Rogeberg O. Assessing the effect of public health information by incentivised risk estimation: An example on Swedish snus. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:51-57. [PMID: 29414485 DOI: 10.1016/j.drugpo.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 12/08/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The provision of accurate information on health damaging behaviours and products is a widely accepted and widespread governmental task. It is easily mismanaged. This study demonstrates a simple method which can help to evaluate whether such information corrects recipient risk beliefs. METHODS Participants assess risks numerically, before and after being exposed to a relevant risk communication. Accuracy is incentivised by awarding financial prizes to answers closest to a pursued risk belief. To illustrate this method, 228 students from the University of Oslo, Norway, were asked to estimate the mortality risk of Swedish snus and cigarettes twice, before and after being exposed to one of three risk communications with information on the health dangers of snus. RESULTS The data allow us to measure how participants updated their risk beliefs after being exposed to different risk communications. Risk information from the government strongly distorted risk perceptions for snus. A newspaper article discussing the relative risks of cigarettes and snus reduced belief errors regarding snus risks, but increased belief errors regarding smoking. The perceived quality of the risk communication was not associated with decreased belief errors. CONCLUSION Public health information can potentially make the public less informed on risks about harmful products or behaviours. This risk can be reduced by targeting identified, measurable belief errors and empirically assessing how alternative communications affect these. The proposed method of incentivised risk estimation might be helpful in future assessments of risk communications.
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Affiliation(s)
- Daniel Bergsvik
- Norwegian Institute of Public Health, Department of Drug Policy, PO Box 4404, Nydalen, 0403 Oslo, Norway; Ragnar Frisch Centre for Economic Research, Gaustadalléen 21, 0349 Oslo, Norway.
| | - Ole Rogeberg
- Ragnar Frisch Centre for Economic Research, Gaustadalléen 21, 0349 Oslo, Norway.
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Lund I, Kvaavik E, Nygård M, Hansen BT. Associations between snus use, body mass index and general health in a cross-sectional population-based sample of women. Scand J Public Health 2017; 46:580-587. [DOI: 10.1177/1403494817748758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: In Norway, snus use among women has increased substantially over the last decade, particularly in younger age groups. Snus use is associated with increased morbidity among men, but few studies have addressed health consequences of snus use among women. Aim: To investigate the associations between body mass index (BMI) and female snus use, and between self-rated general health and female snus use. Methods: A nationally representative net sample of 13,756 women in Norway, aged 18–45 years, participated in a survey on lifestyle and health. Ordinal logistic regression was applied to address associations between snus use and BMI/general health, adjusting for age and lifestyle factors. Results: Compared to never users of snus, daily snus users had a lower likelihood of high BMI (OR: 0.83, 95% CI: 0.68–1.00), a higher likelihood of low BMI (OR: 1.63, 95% CI: 1.14–2.33), and a higher likelihood of poor/fair health (OR: 1.43, 95% CI: 1.08–1.90). Former and occasional snus users did not differ from never users in terms of BMI or general health in multiply adjusted models. Daily smokers had the highest likelihood of reporting poor/fair health (OR: 2.18, 95% CI: 1.8–2.63) relative to never smokers. Conclusions: Daily female snus use was associated with a lower likelihood of being overweight, and a higher likelihood of being underweight. Moreover, daily snus use was associated with a higher likelihood of worse general health. Former and occasional female snus use was not associated with BMI or general health.
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Affiliation(s)
- Ingeborg Lund
- Department of Drug Policy, Norwegian Institute of Public Health, Norway
| | - Elisabeth Kvaavik
- Department of Drug Policy, Norwegian Institute of Public Health, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Norway
| | - Bo T. Hansen
- Department of Research, Cancer Registry of Norway, Norway
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